Systemic Antifungal Therapy
Prior to the diagnosis of AIFR, all patients were stratified into
categories of risk to develop invasive fungal disease according to
accepted guidelines14. High-risk criteria included
acute myelogenous leukemia (AML), high-risk acute lymphoblastic leukemia
(ALL), relapsing leukemia, and post-BMT. High-risk patients received
prophylactic antifungal therapy with itraconazole or fluconazole, as
part of the institutional policy. In addition, all other children with
hematologic malignancies were prophylactically treated with nystatin or
clotrimazole.
Empirical systemic antifungal therapy was administered as soon as AIFR
was suspected. Indications for empirical antifungal treatment included
persistence of fever and neutropenia despite broad spectrum antibiotic
therapy, signs of locally advanced rhinosinusitis, nasal biopsy positive
for calcofluor-white stain or evidence of invasive fungus in frozen
section. Therapy was adjusted after definitive diagnosis and
identification of the pathogen, in accordance with accepted
guidelines15.